ACC 2018 | Risk of MI in Non-Cardiac Surgeries

One in five patients presenting perioperative MI during non-cardiac surgery should be readmitted within 30 days after surgery, and one in seven dies within the same period, according to the new study presented at ACC 2018 scientific sessions and simultaneously published in Circulation.

These infarctions could be considered a iatrogenic complication, given the obvious lack of proper cardiac assessment prior non-cardiac surgery.

More than 1000 patients undergoing perioperative MI (14%) died during hospitalization, compared to only 0.3% of MI in other contexts (p<0.001).

Those that survived hospitalization, despite perioperative MI, had three more chances of readmission within 30 days, vs. those without perioperative MI (19.1% vs 6.5%; p<0.001). These readmissions were due to infections (30%), cardiovascular complications (25.3%) and bleeding (10.4%).


Read also: ACC 2018 | SMART-DATE: 6 Month DAPT Results Suboptimal in ACS.


In those complicated with perioperative MI, mortality was different according to the type of non-cardiac surgery. The record was held by thoracic surgery, with 28.4% mortality rate, followed by general surgery 20.3%, vascular surgery with 15.3% and neurosurgery, with 12.5%.

Coronary revascularization was performed only in 15.8% of patients with perioperative MI, globally: 12.5% of NSTEMI patients were revascularized, vs. only 30.4% of STEMI patients. We should bear in mind that patients had been already been admitted when pain and ST elevation presented, and no action was taken in nearly 70% of cases.


Read also: ACC 2018 | SECURE-PCI: High Dose of Statins pior PCI Could Help.


Playing devil’s advocate, we could say that all these patients were already on painkillers and sedatives, which is why pain could have been disregarded. In addition, without pain to trigger an alarm, an ECG was also overlooked.

Original title: Hospital readmission following perioperative acute myocardial infarction associated with non-cardiac surgery.

Reference: Smilowitz NR et al. Circulation. 2018;Epub ahead of print.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

Coronary Artery Disease in Aortic Stenosis: CABG + SAVR vs. TAVR + PCI: Data from Spanish Centers

Multiple randomized studies have shown comparable or superior efficacy of transcatheter aortic valve replacement (TAVR) vs. coronary artery bypass graft (CABG).  However, many of...

Evolution of Small Balloon-Expandable Valves

Small aortic rings (20 mm) have posed a significant challenge for both surgery and transcatheter aortic valve implantation (TAVI) due to their association with an...

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....